环肺静脉前庭隔离治疗阵发性心房颤动两种手术方法的临床对比研究  

Comparison of different catheter ablation strategies for patient with paroxysmal atrial fi brillation

作　　者：郭炜华[1] 马长生[1,2] 董建增[2] 喻荣辉[2] 陈喆[1] 史旭波[1] 李莉[1] 路亚枫[1] 

机构地区：[1]首都医科大学附属北京同仁医院,北京100730 [2]首都医科大学附属北京安贞医院

出　　处：《中国介入心脏病学杂志》2014年第7期414-417,共4页Chinese Journal of Interventional Cardiology

摘　　要：目的比较环肺静脉电极指引下的肺静脉前庭导管消融与单导管技术隔离肺静脉前庭对阵发性心房颤动(房颤)治疗方法学和疗效的差异。方法 2010年9月至2013年9月共有135例阵发性房颤患者在北京同仁医院接受导管消融治疗,分为环肺电极组54例和单导管消融组81例,行三维标测系统(CARTO)下房颤导管消融。行双侧肺静脉前庭隔离后,比较两组的安全性、时效性和临床效果。结果环肺电极组肺静脉前庭隔离52例(96.3%),单导管消融组78例(96.3%),两组隔离率比较,差异无统计学意义(P>0.05)。在手术操作时间上,单导管消融组明显快于环肺电极组[(76±41)min比(101±32)min,P<0.05]。单导管消融组X线曝光时间明显少于环肺电极组[(12±6.1)min比(24±6.5)min,P<0.05]。随访8个月,不使用抗心律失常药物成功维持窦性心律的患者,环肺电极组43例(79.6%),单导管消融组67例(82.7%),两组差异无统计学意义(P>0.05);环肺电极组有2例肺静脉缩窄的并发症。结论对于阵发性房颤的消融,单导管消融优于环肺静脉电极指引下导管消融,应用单导管技术定位缝隙实现肺静脉前庭的完全隔离安全有效。Objective To compare the clinical outcomes of 2 different catheter ablation stratrgies for patients with paroxysmal atrial fibrillation.Methods 135 patients with paroxysmal atrial fibrillation were divided into 2 groups of different catheter ablation strategies.One group received cirumferential pulmonary rein ablation（CPVA） directed by Lasso（LASSO group,n=54） and the other group received CPVA by single ablation without Lasso （SINGLE ablation group,n=81）.All ablation was guided by 3 dimensional mapping system（CARTO）.After ablation comparison of clinical outcome and safety between two groups was made.Results The baseline characteristics were comparable between the 2 groups.There was no difference in the rates of CPVA in the 2 groups.The mean procedure time and fluoroscopy in the LASSO group was longer than that in the SINGLE group.After the first procedure,79.6％ of patients in the LASSO group and 82.7％ of patients in the SINGLE group were free from symptomatic atrial tachycardia without any use of antiarrhythmic drugs for at least 8 months.Complications including pulmonary vein stenosis（2 case） were recorded in the LASSO group.Conclusions The group of SINGLE ablation showed superiority compared to the LASSO in some outcomes,Single ablation catheter technique is feasible and effective in localizing the residual gaps for complete isolation of the PVAs for ablation of paroxysmal atrial fibrillation.

关 键 词：心房颤动 肺静脉 导管消融术 

分 类 号：R541.7[医药卫生—心血管疾病]